ArticleJournal of critical care2026
Evaluation of opioid requirements in mechanically ventilated patients taking buprenorphine/naloxone prior to admission.
Article in Journal of critical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundWith limited data quantifying opioid requirements based on substance use history, including buprenorphine/naloxone use, optimal pain management for mechanically ventilated patients remains unknown.
objectiveTo compare opioid requirements in mechanically ventilated adults admitted to the intensive care unit (ICU) taking buprenorphine/naloxone prior to admission compared to those who do not.
methodsThis multicenter, retrospective study included adults admitted to a medical ICU and mechanically ventilated for at least 12 h. The primary endpoint was mean hourly opioid rate (fentanyl equivalents [FE], μg FE/h) from intubation until extubation or up to 72 h. Secondary endpoints included sedative requirements and time with pain and depth of sedation scores within goal. To adjust for confounders, a negative binomial model was performed.
resultsOf 176 patients, 47 took buprenorphine/naloxone, 69 were opioid-naïve, and 60 were opioid-tolerant. There was no difference in mean hourly opioid rate between buprenorphine/naloxone (40.8 ± 37.1 μg FE/h) and opioid-naïve (31.7 ± 32.5 μg FE/h; p = 0.17) and opioid-tolerant patients (51 ± 46 μg FE/h; p = 0.22). Multivariable regression demonstrated similar hourly rates in buprenorphine/naloxone and opioid-naïve patients, but opioid-tolerant patients had 50 % higher rates (estimated rate ratio 1.5, 95 % CI [1.01, 2.23]). Time spent with pain scores at goal was similar. Time spent with sedation scores at goal was similar between buprenorphine/naloxone and opioid-naïve patients, but was lower than opioid-tolerant patients.
conclusionPatients taking buprenorphine/naloxone prior to admission who are mechanically ventilated for at least 12 h may have opioid requirements similar to opioid-naïve patients and lower than opioid-tolerant patients.
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